Provider Demographics
NPI:1972856698
Name:MALLORY STEFFEN SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:MALLORY STEFFEN SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-785-2284
Mailing Address - Street 1:701 OPERA HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-1624
Mailing Address - Country:US
Mailing Address - Phone:816-785-2284
Mailing Address - Fax:816-633-4371
Practice Address - Street 1:701 OPERA HOUSE LN
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-1624
Practice Address - Country:US
Practice Address - Phone:816-785-2284
Practice Address - Fax:816-633-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008008306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty